From the Guidelines
Testicular cancer typically presents with a painless testicular mass or swelling, which is the most common initial symptom, as stated in the most recent guidelines 1. The clinical manifestations of testicular cancer can vary, but common symptoms include:
- A painless or painful testicular nodule, mass, enlargement, or induration (hardening) 1
- A feeling of heaviness or dull ache in the scrotum or lower abdomen
- Sudden collection of fluid in the scrotum (hydrocele) or pain and tenderness in the affected testicle In advanced cases, symptoms may include:
- Back or abdominal pain due to retroperitoneal lymph node involvement
- Shortness of breath from lung metastases
- Gynecomastia (breast enlargement) due to hormone-producing tumors
- Constitutional symptoms like fatigue, weight loss, or general malaise may occur with metastatic disease It's essential to note that testicular pain alone is more commonly associated with infection or inflammation rather than cancer, as highlighted in the guidelines 1. Any testicular abnormality should prompt immediate medical evaluation, as early diagnosis significantly improves prognosis, and ultrasound is typically the first diagnostic test performed when testicular cancer is suspected, followed by blood tests for tumor markers such as alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) 1. Regular testicular self-examination is recommended for early detection, as tumors are often discovered by patients themselves. The most recent guidelines emphasize the importance of scrotal ultrasound with Doppler in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm 1. The diagnosis of testicular cancer is based on histology of the testicular mass, and serum tumor markers, including AFP, beta subunit of human chorionic gonadotropin (b-hCG), and lactate dehydrogenase (LDH), are part of the initial work-up and diagnosis 1.
From the FDA Drug Label
Irreversible testicular atrophy was present in rats treated with etoposide intravenously for 30 days at 0. 5 mg/kg/day (about 1/16th of the human dose on a mg/m 2 basis). The clinical manifestations of testicular cancer are not directly addressed in the provided drug label. The FDA drug label does not answer the question.
From the Research
Clinical Manifestations of Testicular Cancer
The clinical manifestations of testicular cancer can be understood through the role of biochemical markers in its diagnosis, staging, and surveillance.
- Human chorionic gonadotropin, alpha fetoprotein, and lactate dehydrogenase play crucial roles in the management of testicular cancer, as discussed in 2.
- These markers are used to guide disease management, including diagnosis, staging, prognosis, monitoring treatment response, and surveillance of seminomatous and nonseminomatous germ cell tumors.
Biomarkers in Testicular Cancer
Biomarkers such as alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-hCG), and lactate dehydrogenase (LDH) are commonly used in the diagnosis and management of testicular cancer.
- However, these conventional markers have limited sensitivities and specificities, as noted in 3.
- MicroRNA-371a-3p (miR371) has emerged as a potential new biomarker with promising features, including a sensitivity of around 90% and specificity >90%, as discussed in 3 and 4.
- The use of miR371 could aid in clinical decision-making, such as discriminating small testicular masses from benign ones, assessing equivocal lymphadenopathies, and monitoring chemotherapy results, as mentioned in 3 and 4.
Limitations of Conventional Markers
Conventional serum tumor markers (STMs) have limitations, including low sensitivity and false-positive elevations due to other benign and malignant conditions.
- As noted in 5, STMs play a critical role in the diagnosis, staging, and follow-up of testicular germ cell neoplasms, but their limitations must be considered.
- The positive predictive value (PPV) of conventional markers is limited, with the highest PPV for βHCG (33.8%) and the lowest for LDH (9.4%), as reported in 6.
- These findings underline the limited accuracy of conventional tumor markers to indicate or rule out a relapse, highlighting the need for improved biomarkers, as discussed in 6.